MEDICARE: CONCERN-PROFESSIONAL SERVICES FOR CHILDREN, YOUTH & FAMILIES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	251S00000X	Community/Behavioral Health Agency
2	261QM0850X	Adult Mental Health Clinic/Center
3	261QM0855X	Adolescent and Children Mental Health Clinic/Center
4	261Q00000X	Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174247084
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONCERN-PROFESSIONAL SERVICES FOR CHILDREN, YOUTH & FAMILIES

Provider Business Mailing Address
First Line	:	1 W MAIN ST
Second Line	:
City	:	FLEETWOOD
State	:	PA
Zip	:	19522-1323
Country	:	US
Telephone Number	:	484-578-9600
Fax Number	:

Provider Business Practice Location Address
First Line	:	269 ROUTE 6 W RM 2
Second Line	:
City	:	COUDERSPORT
State	:	PA
Zip	:	16915-8465
Country	:	US
Telephone Number	:	570-724-7142
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	GORDON H MAY
Credential	:
Telephone Number	:	484-578-9600

Provider Enumeration Date	:	10/04/2022
Last Update Date	:	05/25/2023

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